Retrospective Analysis Of Risk Factors And Preventive Treatment Of Opioid-Induced Constipation In Patients With Cancer Pain

ObjectivesThe aim of this retrospective clinical study was to screen the risk factors of opioid-induced constipation(OIC)and evaluate the prophylactic treatment efficiency of laxatives combined with/without prokinetic agents in cancer pain patients.Better understanding of these issues will provide clinical evidences to current insufficient preventive OIC treatment in cancer pain patients and improve their quality of life.Materials and MethodsClinical data was collected from the Department of Oncology,Jinan Central Hospital Affiliated to Shandong University during January 1,2014 to September 1,2017.According to the enrollment and exclusion criteria,235 cancer pain patients who received opioids for more than 2 weeks were eligible for study.U test,?2 test and logistics regression analysis were used to evaluate the risk factors of OIC,while ?2 test was used to investigate the prophylactic treatment efficiency of laxatives combined with/without prokinetic agents.Results1.Baseline Characteristics of PatientsAmong the eligible 235 patients,148 are male and 84 female.Their ages ranged from 30 to 91 years old with the average age of 64.97 years old.The PS score for 131 patients(55.8%)were 0 to 1,while 104 patients(44.2%)were 2 to 4.Most patients were diagnosed as gastrointestinal cancer(n=95,40.4%)and lung cancer(n=77,32.8%)and 208 patients(88.5%)had stage ? diseases by TNM staging system.The used analgesics contain morphine sulfate sustained release tablets and oxycodone hydrochloride prolonged-released tablets.And the laxatives for prophylaxis included lactulose(n=110)or polyethylene glycol(n=4),while the prokinetic agents were mosapride(n=22)or cerekinon(n=2).2.Risk factors for OICPatients were devided as OIC group and non-OIC group based on the OIC development.No significant differences was founded in age,sex and PS score between the two groups,while significant differences was founded in tumor type,analgesic dose and the usage of prophylaxis agents(all p<0.05).Patients diagnosed as gastrointestinal tumor,or taking high dose of opioid-analgesic(morphine-equivalent dose ?60mg/d),or not be preventively treated had a higher OIC incidence.In addition,all patients taking opioid agents more than 400mg/d(morphine-equivalent dosage)had OIC.The logistic regression analysis indicated all those three factors were independent risk factors for OIC.3.Effects of prophylaxis agents on OIC incidenceComparation of OIC incidence among different prevention methods showed that patients with drug prophylaxis have significant lower OIC incidence than patients without drug prophylaxis(42.98%VS 61.12%,p=0.005).And OIC incidence was slightly lower in the patients with combined laxatives and prokinetic agents compared with those with laxatives,but there was no statistical difference between the two groups(33.33%VS 45.56%,p=0.283),maybe because of the limited sample size in combination group.ConclusionPatients with gastrointestinal cancer or taking high-dose opioid are susceptible to OIC.Prophylaxis treatment of OIC using lactulose and polyethylene glycol can significantly reduce the incidence of OIC,while combined laxative with prokinetic agents trended to further decline OIC occurrence.Therefore,prophylaxis treatment with laxative combined with/without prokinetic agents was recommended to patients taking opioid analgesics to prevent QIC,especially to whom having gastrointestinal cancer or requiring high-dose opioid-analgesic.We are looking forward to large prospective clinical study to provide better evidences and guide clinical practices.